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Objective:To investigate the risk factors associated with mortality in patients with severe traumatic liver injury (TLI) and to establish and validate an early prediction model for mortality.Methods:A retrospective cohort study was conducted to analyze the clinical data of 273 patients with severe TLI admitted to the ICU from the medical information mart for the intensive care-IV (MIMIC-IV) database. The cohort consisted of 176 males and 97 females, with age ranging from 18 to 83 years [35.6 years(25.7,57.5)years]. The patients were divided into two groups based on in-hospital mortality: the survival group (253 patients, 92.7%) and the death group (20 patients, 7.3%). The two groups were compared with regards to gender, age, cause and type of injury, treatment method, massive blood transfusion, comorbidities as well as vital signs and laboratory tests measured within 24 hours of ICU admission. Univariate analysis was used to screen for risk factors associated with mortality in severe TLI patients. Independent risk factors for mortality were determined using multivariate Logistic regression analysis. Lasso regression was used to screen for predictors of mortality, and a nomogram prognostic model was then established through a multivariate Logistic regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discrimination of the model, while the Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to evaluate the calibration of the model. The model′s clinical applicability was evaluated through decision curve analysis (DCA). Internal validation was performed by the 200 Bootstrap samples, and external validation was performed by using 163 patients with severe TLI from the emergency ICU collaborative research database (eICU-CRD). Finally, the predictive efficacy of the nomogram model was compared to other trauma or severity scores.Results:Univariate analysis showed that the age, cause of injury, massive blood transfusion, chronic liver disease and laboratory tests measured within 24 hours of ICU admission, including temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, shock index, platelets, red blood cell distribution width (RDW), mean red blood cell hemoglobin concentration (MCHC), blood glucose, blood urea nitrogen, creatinine, anion gap, bicarbonate, prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were associated with the mortality of severe TLI patients ( P<0.05 or 0.01). Multivariate Logistic regression analysis revealed that age ( OR=1.08, 95% CI 1.03, 1.12, P<0.01), body temperature <36 ℃ ( OR=8.00, 95% CI 2.17, 29.53, P<0.01), shock index ( OR=9.59, 95% CI 1.76, 52.18, P<0.01) and anion gap ( OR=1.32, 95% CI 1.15, 1.53, P<0.01) were significantly associated with mortality in severe TLI patients. Lasso regression analysis selected 7 predictors, including age, body temperature<36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT. Based on these 7 predictors, a nomogram prediction model was developed. The AUC of the nomogram for predicting mortality was 0.96 (95% CI 0.94, 0.99), and the Hosmer-Lemeshow goodness-of-fit test indicated a good fit ( P>0.05). The calibration curve demonstrated excellent consistency between the predicted and actual probabilities, and DCA demonstrated that the model had good clinical net benefit at all risk threshold probability ranges. Internal validation confirmed the stability of the model ( AUC=0.96, 95% CI 0.92, 0.98), and external validation demonstrated good generalization ability ( AUC=0.95, 95% CI 0.91, 0.98). Moreover, the nomogram exhibited superior predictive efficacy compared with injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS), sequential organ failure score (SOFA), acute physiological score III (APS III), Logistic organ dysfunction score (LODS), Oxford acute severity of illness score (OASIS) and simplified acute physiological score II (SAPS II). Conclusions:Age, body temperature <36 ℃, shock index and anion gap are independent risk factors for mortality in severe TLI patients. A nomogram prognosis model based on 7 predictors, namely age, body temperature <36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT exhibits good predictive efficacy and robustness, and is contributive to accurately assess the risk of mortality in severe TLI patients at an early stage.
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Objective:To investigate CK19 and COX-2 expression in papillary thyroid carcinoma (PTC) and their relationship with clinicopathologic parameters.Methods:Retrospective study of 120 consecutive patients with PTC who underwent resection from May. 2017 to Dec. 2020 was conducted. The expression of CK19 and COX-2 in 120 pieces of primary PTC tissue and 30 pieces of adjacent carcinoma tissue were detected by EliVision TM plus two-step immunohistochemical method. The relationship between the expression of CK19 and COX-2 and the clinicopathologic parameters including patient age, TI-RADS classification, TNM staging, carcinomatous infiltration, lymph node metastasis was studied. The analysis was performed using SPSS 22.0 software. The numerical data were presented as numbers and percentages, and chi-test ( χ2 test) and Pearson’s correlation were used to analyze the difference and association between two groups. P<0.05 was considered statistically significant. Results:The positive immunostaining of CK19 and COX-2 were mainly localized in the cytoplasm. The positive rates of CK19 and COX-2 were 87.50% (105/120) and 72.50% (87/120) in cancer tissues and 10.00% (3/30) and 3.33% (1/30) in paracancerous tissues, respectively, with statistically significant differences (both P<0.05 by χ2 test) . In the groups with patients aged <45 years versus ≥45 years, the CK19 positive rates were 88.16% (67/76) and 86.36% (38/44) , and the COX-2 positive rates were 69.74% (53/76) and 77.27% (34/44) , respectively. In the groups of TI-RADS (grade 4 and 5) versus grade 6, the CK19 positive rates were 85.26% (81/95) and 96.00% (24/25) , and the COX-2 positive rates were 69.47% (66/95) and 84.00% (21/25) , respectively, with no statistically significant differences between the two groups (both P>0.05) . In the groups of TNM (stage T1 and T2) versus stage T3, the CK19 positive rates were 82.28% (65/79) and 97.56% (40/41) , and the COX-2 positive rates were 65.82% (52/79) and 85.36% (35/41) , respectively. In the groups with versus without cancer infiltration, the CK19 positive rates were 94.44% (68/72) and 77.08% (37/48) , and the COX-2 positive rates were 83.33% (60/72) and 56.25% (27/48) , respectively. In the groups with versus without lymph node metastasis, the CK19 positive rates were 95.59% (65/68) and 76.92% (40/52) , and the COX-2 positive rates were 83.82% (57/68) and 57.69% (30/52) , respectively, and the differences between the above groups were statistically significant (all P<0.05 by χ2 test) . The co-positive and co-negative expression rates of CK19 and COX-2 in 120 patients were 70.83% (85/120) and 10.83% (13/120) , respectively, with a positive correlation ( r=0.45, P<0.05 by Pearson’s correlation) . Conclusions:The positive rates of CK19 and COX-2 expressions are not related to patient’s age or TI-RADS classification, but closely related to TNM stage, cancer invasion and lymph node metastasis. The up-regulation of both CK19 and COX-2 expressions predicts higher tumor stage, more aggressive invasion and more prone to lymph node metastasis.
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Objective To investigate the expression and clinical significance of HGF and C-Met in cholangiocarcinoma .Meth-ods The levels of HGF and C-Met were measured by ELISA ,the expression of HGF and C-Met in cholangiocarcinoma and health control was detected by immunohistochemistry .Results The preoperative levels of HGF and C-Met in cholangiocarcinoma were higher than the health control(P< 0 .05) .Compared with the preoperative state ,the levels of HGF and C-Met in cholangiocarcino-ma on the 3rd day after operation did not change significantly .However ,the levels of HGF and C-Met on the postoperative 7th and 10th day decreased obviously .In addition ,the expression of HGF and C-Met in cholangiocarcinoma was 76 .2% ,81 .0% ,respective-ly ,which is higher than that in normal tissue ( P < 0 .01) .Conclusion There is an abnormal expression of HGF and C-Met in cholangiocarcinoma ,which may be related to the incidence and development of cholangiocarcinoma .
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Objective To investigate the expression of calcium-binding protein S100A4 in pancreatic carcinoma and its clinical significannce.Methods Immunohistochemistry EliVisionTM Plus method was used to examine the expression of S100A4 in 70 surgical specimens of primary pancreatic carcinoma and 15 patients with noncarcinoma pancreatic tissues.The correlation between the expression of S100A4 and the clinicopathological parameters was analyzed.Results S100A4 was positive in 52(52/70,74.3％) specimens of primary pancreatic carcinoma according to immunohistochemistry detection.No expression of S100A4 in adjacent noncarcinoma pancreatic tissues was detected.The expression of S100A4 did not correlated with gender,age or tumor site while it was significantly correlated with tumor size,grade of differentiation,TNM stages,lymph node metastasis and survival.Disease-free survival and overall survival of the negative group were significantly longer than the positive group.The difference had statistical significance.Conclusion The study shows that over expression of S100A4 protein is closely related with clinicopathological parameters of pancreatic cancer patients,indicating poor prognosis for pancreatic cancer patients.
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Objective To investigate the correlation between the expression of cyclooxygenase-2 (COX-2),vascular endothelial growth factor(VEGF) protein,and metastasis in human papillary thyroid carcinoma (PTC).Methods lmmunohistochemical method was used to detect the expression of COX-2 and VEGF protein in 66 cases of PTC,20 cases of thyroid adenoma (TA),20 cases of nodular goiter (NG) and 15 cases of adjacent noncancerous (AN) tissues.Results The positive expression rate of COX-2 (72.7％,48/66)and VEGF (59.1％,39/66) was significantly higher in PTC than in TA( 10.0％,15.0％ ),NG( 15.0％,20.0％ )and AN (0.0％,13.3％ ) (P ＜0.05).The expression of COX-2 and VEGF was closely related to invasion,metastasis,and survival duration of PTC patients (P ＜0.05).Conclusion The expression of COX-2 and VEGF is closely related to biological behaviors of PTC patients and can be taken as prognostic indicators for PTC patients.
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ObjectiveTo investigate the expression of adhesion molecules cyclooxygenase-2 (COX-2)and survivin protein in elderly patients with gastric cancer and their relationship with the pathological behavior and prognosis,MethodsImmunohistochemical staining was used to detect the expression of COX-2 and survivin protein in 60 cases of elderly patients with gastric carcinoma,30 cases of gastric epithelial dysplasia and 20 cases of normal gastric mucosa.The study was also combinedwith analysis of the pathological behavior and clinical follow-up survey of elderly patients with gastric carcinoma.ResultsThe positive expression rates of COX2 and survivin protein in elderly patients with gastric carcinoma were 63.3％(38/60) and 70.0％(42/60),respectively.The positive rates of COX-2 and survivin in elderly patients with gastric carcinoma were higher than that in epithelial dysplasia and normal gastric mucosa( P ＜0.05).The expression of COX-2 and survivin were closely related to the infiltration of serosa,metastasis of lymph node and prognosis of patients ( P ＜ 0.05 ).ConclusionThe expression of COX-2 and survivin are closely related to carcinogenesis,metastasis and survival time in elderly patients with gastric carcinoma.Detecting the expression of COX-2 and survivin may be prognostic indicators of elderly patients with gastric carcinoma.
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ObjectiveTo explore the correlation of expression of galetin-3 (Gal-3) and epidermal growth factor receptor (EGFR) with the biological behaviors in esophageal squamous carcinoma(ESC). MethodsImmunohistochemical method was used to examine the expression of Gal-3 and EGFR in 80 specimens of ESC. ResultsThe positive rates of Gal-3 and EGFR was 73.8％ (59/80)and 56. 3％ (45/80)respectively. The positive rates of Gal-3 and EGFR expression in the patients with poor differentiation, deep infiltration and lymph node metastasis was significantly higher than those with well differentiation, shallow infiltration and without lymph node metastasis ( P ＜ 0. 05 ). The high expression of Gal-3 and EGFR was correlated with higher percentage of death and lower survival rate ( P ＜ 0.05 ). ConclusionThe abnormal expression of Gal-3 and EGFR is closely related with the pathological biology behaviors of ESC. Gal-3 and EGFR can be regarded as objective indicators for forecasting metastasic potential of ESC and estimating prognosis of patients with ESC.
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Objective To investigate the expression of S100A4 protein in benign and malignant thyroid tissues and its clinical significance. Methods Expression of S100A4 protein in thyroid cancers (50 cases), adenoma (45 cases) and adjacent noncancerous tissue (20 cases) was respectively studied by microwave-LSAB immunohistochemical staining. Results The positive rate of S100A4 protein in thyroid cancer and adenoma was 78.0% and 15.6% respectively. No S100A4 protein expression was found in any adjacent noncancerous tissue (P ＜0. 01). No correlation was observed between expression of S100A4 protein and histological grading of thyroid cancer. Expression of S100A4 protein in lymph node metastasis and staging Ⅲ-Ⅳ was both higher than that in negative cases and staging Ⅰ -Ⅱ (P ＜0. 05). The rate of recurrence and death in S100A4 protein positive cases were notably higher than that in negative cases (P ＜ 0. 05). Conclusions S100A4 protein expression can help to distinguish benign and malignant thyroid tissues. It can be used as a molecular marker to predict thyroid metastasis.
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Objective To investigate the expression of matrix metalloproteinases-7 (MMP-7) in benign and malignant thyroid tissues and its clinical significance. Methods The expression of MMP-7 in 50 thyroid cancers, 45 adenoma and 20 adjacent noncancerous portion tissues were studied by microwave-LSAB immunohistochemical method. Results The positive rate of MMP-7 in thyroid cancer was 64. 0%, which was significantly higher than 37. 0% in adenoma and 25.0% in adjacent noncancerous portion(X_2=8. 72,6. 52, P < 0.01 ). No correlation was observed between the expression of MMP-7 and histological grading of thyroid cancer. The expression of MMP-7 in lymph node metastasis and Grade Ⅲ～Ⅳ were both higher than that in negative cases and in Grade Ⅰ～Ⅱ ( P < 0. 05 ). The percentage of recurrence and death in MMP-7 positive cases were notably higher than that in negative cases( P <0. 05). Conclusion The expression of MMP-7 can be regarded as a parameter for evaluating the degree of malignancy, biological behavior and prognosis of thyroid cancer.
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Objective To investigate the correlation of expression of SLeX and p16 gene protein with the potential of invasion and metastasis in papillary thyroid carcinoma(PTC). Methods The expression of SLeX and p16 gene protein in 69 cases of PTC were studied by microwave-labelled strept-avidin biotin immunohistochemical method. Results The positive rates of SLeX and p16 in PTC were 69.6% and 58.0% respectively. The posi-tive rate of SLeX expression in the patients with tumor invasion and lymphatic metastasis was significantly higher than that without tumor invasion and lymphatic metastasis (P<0.05). But the positive rate of p16 expression in the patients with tumor invasion and lymphatic metastasis was significantly lower than that without tumor invasion and lymphatic metastasis (P <0. 05). There was a negative correlation between SLeX and p16 expression in PTC (P <0. 05). Conclusions Expression of SLeX and p16 protein were closely correlated with the invasive and metastasic potential in PTC. SLeX and p16 could be considered as prognostic indications for PTC.
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Objective To investigate the expressions of matrix metalloproteinase-26(MMP-26) and sialyl Lewis-X(SLeX) in breast carcinoma and their relation with lymphaden metastasis.Methods The expressions of MMP-26 and SLeX protein in breast carcinoma(n=120),metastatic lymph node(n=71) and normal mammary gland tissue(n=30) were studied by catalyzed signal amplification(CSA) immunohistochemical method.Results The positive rate of MMP-26 and SLeX protein expression were 16.7%(5/30) and 20.0%(6/30) in normal breast tissues,and 63.3%(76/120) and 86.7%(104/120) in breast carcinoma,resepectively.The expressions of MMP-26 and SLeX protein in breast carcinoma tissues were significantly higher than those in remote normal breast tissues(P0.05).The positive rate of MMP-26 and SLeX protein expression were 23.9%(17/71) and 88.7%(63/71) in metastatic lymph node,resepectively.The expression of SLeX protein in metastatic lymph node was correlated with that in tissues of breast carcinoma(r=0.874,P
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<p><b>OBJECTIVE</b>To study the expression of CD44v6 and E-cadherin(ED) in prostate carcinoma in relation to the metastasis of prostate carcinoma.</p><p><b>METHODS</b>The expression of CD44v6 and ED in 45 cases of prostate carcinoma was studied with immunohistochemical technique.</p><p><b>RESULTS</b>The positive expression rates of CD44v6 and ED in prostate carcinoma were 77.8% and 48.9%, respectively. The high level expression of CD44v6 and the low level expression of ED were positively correlated with differentiation, clinical staging and metastasis of prostate carcinoma (P < 0.05). The expression of CD44v6 was negatively correlated with ED(r = -0.58, P < 0.005).</p><p><b>CONCLUSIONS</b>The expression of CD44v6 and ED protein might be a useful marker for prostate carcinoma in evaluating the biological behavior and prognosis of the tumor.</p>
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Humans , Male , Cadherins , Cell Differentiation , Glycoproteins , Hyaluronan Receptors , Immunohistochemistry , Neoplasm Metastasis , Prostatic Neoplasms , Chemistry , PathologyABSTRACT
Objective To investigate the expression and distribution of sialyl Lewis X in colorectal carcinoma and its relationship with carcinogenesis, progression and metastatic proclivity.Methods Microwave LSAB immunohistochemical technique was used to detect the expression of sialyl Lewis X in colorectal carcinoma and in normal mucosa. Immunoelectromicroscopic localization of sialyl Lewis X labelled by colloidal gold was also observed.Results The positive rate of sialyl Lewis X expression in primary colorectal cancer was 92 2%(83/90), and 16 7%(5/30) in normal mucosa. The positive rate was 100% in patients with lymphatic nodes metastasis, compared with that of negative nodes of 82 1% ( P
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Objective To investigate the level of cell adhesion molecule sialyl-LeX expression in colorectal carcinoma and its relation with carcinogenesis, differentiation, metastasis and prognosis. Methods Sialyl-LeX expression and its optical density in colorectal carcinoma (n=90) and remote normal mucosa (n=30) were quantitatively studied with microwave-LSAB immunohistochemical method combined with image analysis technique. Fifty-three patients were followed up. Results The weaker staining in remote normal colorectal mucosa was observed in very limited parts of some deep crypts. Positive rate of sialyl-LeX expression was only 16.7%(5/30). The positive expression of sialyl-LeX was observed in 83 of 90 patients with colorectal carcinoma(92.2%). The apical cytoplasma of cancer tubules, the luminal contents, and the cytoplasma of the cancer cells were strongly stained. The mean integral optical density of sialyl-LeX positive cell in poorly differentiated adenocarcinoma was significantly higher than that in highly differentiated and mucinous ones (P<0.01). It was markedly higher in patients with positive lymphatic nodes than that in negative ones (P<0.01). With followed-up for longer than 5 years, it was much lower in the alive cases than that in the dead (P<0.01). Conclusion These findings indicate that changes of sialyl-LeX expression and its optical density is related to carcinogenesis, differentiation, invasion and metastasis of colorectal carcinoma. It may be a good predicter for the prognosis of patients with colorectal carcinoma.
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Objective To evaluate the effect of self-expandable nitinol mesh stent (SENMT) for advanced rectal cancer accompanied with obstruction. Methods Clinical data were retrospectively analysed on 12 patients with advanced rectal cancer accompanied with acute or chronic obstruction treated by the stent placement. Results SENMT was placed successfully in 10 patients including replacement in 2 patients because of the stent was migrated. The bowel movement recovered in all of the 10 patients. Ten patients were followed-up, 5 cases died within 56-720 days, and 5 others survived without intestinal obstruction for 6-15 months. The stent failed to be placed in other 2 patients. Conclusions SENMT may be useful in the management of terminal or high-risk surgical patients for palliative purposes. Palliation management of stent placement combined with chemotherapy and immunotherapy might prolong the survival time of these patients.
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Purpose:To investigate the relationship of expression of CD44v6, E cadherin (E Cad) with clinic biologicl behavior in breast cancer and its correlation. Methods:Catalyzed signal amplification immunohistochemical method was used to detect the expression of CD44v6 and E Cad in 94 cases of breast cancer.Results:The positive expression of CD44v6 and the negative expression of E Cad were positively correlated with the grading, clinical stage, lymph node metastasis recurrence and prognosis of breast cancer. In breast cancer, the expression of CD44v6 had negative correlation to that of E Cad.Conclusions:Several genes were involved in the occurrence and development of breast cancer in which the expression of CD44v6 had negative regulative synergistic action with that of E Cad. CD44v6 and E Cad expression, as a clinical valuable marker, has a great significance in assessing node metastasis and survival.
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Ojective To enhance the ability of diagnosis and therapy for occult indirect inguinal hernia. Methods Surgical exploration was performed for patients highly suspected with occult indirect inguinal hernia based on clinical manifestations and physical examinations in the initial stage. At present, herniography was used to confirm the diagnosis. High ligation of the hernial sac, non-mesh methods of open groin hernia repair or tension-free inguinal hernia repair was performed for the patients. Results Forty-four cases were given surgical exploration in the initial stage and 41 cases were confirmed and treated by operation. Misdiagnosis was found in 3 cases and surgical exploration revealed no sign of disease. Relapse occurred in two cases within 5 years. Nineteen out of 30 patients were confirmed by herniography in the last five years and operated on. There was no false-positive herniogram in this series. Follow-up evaluation of the patients showed disappearance of preoperative symptoms. Groin hernia has not recurred so far. Conclusions The ability of diagnosis for occult indirect inguinal hernia can be enhanced by herniography. Blind surgical exploration can be reduced. Herniography is a safe, reliable and practical diagnostic procedure.
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To evaluate initial experience with shape memory alloy stent as an alterative to colostomy in patients with intestinal obstruction by colorectal cancer, forty four patients diagnosed with acute and chronic colorectal obstructions from malignant causes were subjected to stent placement. Among them 41 patients achieved clinical decompression. Thirty three cases died within 51～720 days and the other 5 cases were still alive without intestinal obstruction for 1～8 months. Our conclusions are shape memory alloy stent may be useful in the management of terminal or high risk surgical patients for palliative purposes instead of colostomy. Palliative management by stent placement combined with chemotherapy and immunotherapy might prolong the survival time of these patients. Placement of stent for acute colorectal bowel obstructions facilitates preoperative bowel preparation for surgical resection and obviates the need for fecal diversion or on table lavage.
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To investigate the relationship of expression of sialyl Lewis X (SLeX) antigen,CD44v6 and E cadherin(ED) with staging,infiltration,node metastasis and prognosis in breast cancer, immunohistochemical method was used to detect their expression in 94 cases of breast cancer.The positive expression of SLeX,CD44v6 and the negative expression of ED were positively correlated with the grading, clinical staging, lymph node metastasis recurrence and prognosis of breast cancer.The results demonstrated that the expression of SLeX, CD44v6 and ED as a clinical valuable marker,has a great significance in assessing node metastasis and prognosis.
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Objective:In order to study the correlation between The expression of CD44v6 protein and Bcl-2 protein in thyroid cancer were examined.Methods:The expression of CD44v6 and Bcl-2 in 50 thyroid cancers,20 adjacent noncancerous portion,45 adenoma and 10 normal thyroid tissue were respecitively investigated by catalyzed signal amplification immunohistochemical technique. Results:The positive rate of CD44v6 and Bcl-2 in thyroid cancer was 64.0% and 46.0%, which was significantly higher than that in adenoma or adjacent noncancerous ( P